Cardiovascular diseases (CVDs) remain a leading cause of morbidity and mortality worldwide. Traditionally, risk assessment for CVD has focused on lipid profiles, particularly low-density lipoprotein cholesterol (LDL-C). However, recent guidelines from the American College of Cardiology (ACC) have highlighted the importance of incorporating inflammation markers, specifically high-sensitivity C-reactive protein (hsCRP), into cardiovascular risk assessment.
High-sensitivity C-reactive protein is a protein produced by the liver in response to inflammation. Unlike standard CRP tests, hsCRP can detect low levels of the protein, making it useful for identifying low-grade inflammation that may not be apparent through other clinical signs.
Elevated hsCRP levels have been associated with an increased risk of atherosclerotic cardiovascular diseases, including heart attacks and strokes.
In 2019, the ACC/American Heart Association (AHA) guidelines on the primary prevention of cardiovascular disease acknowledged hsCRP as a "risk-enhancing factor" for individuals at intermediate risk based on traditional lipid measures. This means that for individuals whose risk of a cardiovascular event is not clearly high or low, measuring hsCRP can provide additional information to guide treatment decisions 1AHA Journals.
The 2025 ACC scientific statement further emphasized the role of hsCRP, recommending its measurement in all patients being evaluated for cardiovascular risk, both in primary and secondary prevention settings.2
The statement notes that clinicians are less likely to address risk factors that are not measured, suggesting that routine screening of hsCRP, alongside lipid profiles, represents a significant clinical opportunity.
Commenting on the current suggestion, Dr. Munish Kumar Raizada, MD FAAP, mentioned that "although serum CRP typically has good sensitivity but low specificity, adding it to the battery of test for heart will give some more assurance."
For individuals with elevated hsCRP levels:
Primary Prevention: Even in the absence of elevated LDL-C, high hsCRP levels may indicate a higher risk of cardiovascular events.
Secondary Prevention: In patients with established cardiovascular disease, hsCRP levels have been found to be as predictive of future events as LDL-C levels, even in those undergoing statin therapy. If hsCRP remains elevated despite statin use, clinicians might consider increasing the statin dose or adding other therapies to address residual inflammatory risk. 2
Beyond pharmacological interventions, lifestyle changes play a crucial role in managing inflammation:
Exercise: Engaging in regular physical activity, such as at least 150 minutes per week, can help reduce systemic inflammation.
Diet: Adopting anti-inflammatory diets, like the Mediterranean or DASH (Dietary Approaches to Stop Hypertension) diets, has been shown to lower hsCRP levels.
Omega-3 Fatty Acids: Consuming omega-3 fatty acids, found in fatty fish, can also contribute to reducing inflammation.
These lifestyle modifications not only help in managing hsCRP levels but also promote overall cardiovascular health.
Conclusion
The integration of hsCRP measurement into cardiovascular risk assessment provides a more comprehensive understanding of an individual's risk profile.
References
1. Arnett, D. K., B. S. Blumenthal, J. M. Albert, et al. "2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines." Circulation 140, no. 11 (2019): e596–e646. https://doi.org/10.1161/CIR.0000000000000678.
2. "High-Sensitivity C-Reactive Protein in Atherosclerotic Cardiovascular Disease: Measure or Not?" USC Journal. Last modified March 21, 2025. https://www.uscjournal.com/articles/high-sensitivity-c-reactive-protein-atherosclerotic-cardiovascular-disease-measure-or-not?language_content_entity=en.
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